Monday, October 08, 2007

The Council of Europe adopts convention on promoting public health in drug control

The Council of Europe, representing 47 member states and a population of over 800 million people, has adopted a convention on promoting public health policy in drug control. This move marks a very positive evolution in international drug policy thinking; away from the heavy handed enforcement focus of old school prohibition, towards an more evidence based public health focus for future pan-European policy. The full text is reproduced below.

Whilst the convention's power is essentially rhetorical, it is reassuring that the broad thrust of the convention has been supported by UK, Sweden and other traditionally more dogmatic / enforcent oreiented European states (although some compromise is evident - in terms of supporting enforcement e.g. point 11.8 - there's also a clear acknowledgement in the preamble that supply side efforts have been costly and ineffective and that a public health and harm reduction paradigm should be the focus of future policy).

The convention arrives at a timely moment in the evolution of both domestic and international drug policy with the UK and UN's ten year strategies being held up to scrutiny and a window of opportunity opening for new thinking to help shape the next ten year strategies. The convention is also a welcome endorsement for the Drugs and Health Alliance with which it shares many core principles.

For a European convention on promoting public health policy in drug control

Resolution 1576 (2007)1

1. Drug addiction is a complex biological, psychological and societal problem. Scientific research and practical experience have made it possible to broaden our knowledge of it. Increasingly, this improved knowledge allows the implementation of a drugs policy focused on preserving public health, for individual addicts and for society. Although many scientific questions concerning dependency remain unanswered, the aspects linked to public health, the effectiveness of prevention and of medical treatments and improved protection of society against the resulting health risks are now better known.

2. Since the late 1960s, considerations of public health have played an increasing role in pragmatic, evidenced-based drug policy-making in many member states of the Council of Europe. The right to health provides the cornerstone principle on which such considerations are based. This right is recognised in the Council of Europe acquis (Articles 11 and 13 of the Revised European Social Charter) as well as in numerous other international and regional human rights treaties. It grants every individual the right to the enjoyment of the highest attainable standard of health, defined by the World Health Organization as a state of complete physical, mental and social wellbeing.

3. A number of key public health responses to “problem drug use” have emerged in past decades, including substitution treatment, needle exchange programmes and psychosocial treatment. These measures have had a marked effect on the successful long-term rehabilitation of drug users and their reintegration into society. The resultant benefits have been felt by society as a whole, through reductions in the incidence of criminal behaviour, reduced costs for health and criminal justice systems, reduced risks of transmission of HIV and other blood-borne viruses, increased productivity and ultimately reduced drug use levels.

4. However, these responses have so far been employed only on a fragmentary basis across Europe. This is despite the fact that their utility and cost-effectiveness is now widely documented. According to estimates cited by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), for example, every dollar invested in opioid dependence treatment programmes may yield a return of between $4 and $7 in reduced drug-related crime, criminal justice costs and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12:1.

5. Moreover, recent world trends have provided additional proof of the abject failure of efforts to reduce the production and supply of drugs. The current illegal drugs market in Afghanistan, the world’s largest producer of heroin, provides ample evidence of the ineffectiveness to address the drugs problem in a comprehensive manner. Despite six years of military action to restrict the poppy crops in the country, the United Nations have confirmed that poppy crop production in Afghanistan has increased by 60% for the year 2006-2007 compared to the previous year.

6. Steps being taken in the European Union as part of the EU Drugs Strategy 2005-12 aim to achieve a high level of health protection by complementing EU member states’ action in preventing and reducing drug use and dependence and drug-related harm to health and society. In particular, the strategy places a high priority on improving access to a range of public health orientated responses that can reduce the morbidity and mortality associated with drug dependence. However, it is clear that special efforts need to be taken in relation to Eastern Europe and Central Asia, where political and infrastructural obstacles have hindered the implementation of such responses. The escalating HIV/AIDS pandemic in these regions provides an added urgency to this imperative: 80% of HIV cases with a known route of transmission in Eastern Europe and Central Asia are due to injecting drug use.

7. The geographic sphere of influence of the Council of Europe makes it the ideal forum to undertake such efforts and send an unequivocal signal giving a framework to its member states to develop public health-orientated responses to problem drug use. In pursuit of this end, which has been emphasised by the Pompidou Group and the International Federation of Red Cross and Red Crescent Societies, the Parliamentary Assembly calls upon member states to work together to design a convention promoting public health policy in drug control. This convention should complement existing legal instruments in the areas of drug control, human rights and public health. It should consolidate scientific and medical knowledge in a framework document which may form the basis for the design of national drug strategies.

8. The Council of Europe convention should be predicated on the following three inter-related objectives to:

8.1. promote, as a fundamental human right, the right to health in the context of problem drug use;

8.2. clarify the scope of the right to health as it applies to problem drug use;

8.3. help identify good practices for the operation of the right to health as it applies to problem drug use, at the community, national and international levels.

9. In pursuit of these objectives, the convention, which should be complementary to the existing framework of national drug policies, should incorporate the following four elements:

9.1. prevention and education, including measures targeting the special needs of marginalised and vulnerable groups;

9.2. treatment, covering a range of treatment methods, including substitution treatment and needle exchange programmes, and incorporating a psychosocial component as integral to the various treatment methods;

9.3. rehabilitation and social reintegration, including treatment alternatives to imprisonment and labour market rehabilitation;

9.4. monitoring and evaluation, aimed at identifying best practices.

10. Insofar as many of the negative consequences of drug use are felt at local levels, the convention should also seek to reaffirm the principle of subsidiarity, by encouraging consideration of the ways that more local government agencies may act effectively. In this way, it is intended that health-driven drug policy responses be guided by scientific evidence as well as local conditions.

11. In order to promote the effective implementation of the convention, the Assembly calls on member states to:

11.1. extend the scope of drug demand reduction programmes, assess them and disseminate the best practices assessed;

11.2. improve access to prevention programmes in schools and make them more effective;

11.3. improve prevention methods and the detection of risk factors in certain target groups, especially young people, as well as the dissemination of these data to the professionals in order to implement early intervention programmes;

11.4. ensure that targeted treatment, re-education and social reintegration programmes are available and accessible. These programmes should incorporate tested psychosocial and pharmacological strategies, and include drug addicts not reached by existing services with particular attention being paid to specialised services for young people, and rehabilitation of drug addicts in the labour market;

11.5. develop further alternatives to imprisonment for addicts and the setting-up of prevention, treatment and reintegration services for prisoners;

11.6. improve access to harm reduction services and treatment and set up programmes preventing the propagation of the AIDS virus, hepatitis C and other blood-borne diseases and endeavour to reduce the number of drug-related deaths;

11.7. encourage research into the factors underlying dependency and such questions as the effects of certain drugs and effective health measures;

11.8. implement operational enforcement programmes in order to reduce the production of heroin, cocaine and cannabis, as well as synthetic drugs and trade in them, in particular by devising operational joint programmes, collecting intelligence on third countries involved in manufacturing and trading in such drugs, sharing best practice and exchanging information;

11.9. devise and implement measures targeted at money laundering and the seizure and re-use of financial products connected with drugs, in particular through exchanges of information and best practices;

11.10. encourage co-operation with international organisations such as the International Federation of Red Cross and Red Crescent Societies and the EMCDDA, as well as with civil society and community groups from areas most affected by problem drug use;

11.11. encourage the creation, in national parliaments, of mechanisms and structures which promote public health responses to problem drug use in the national context, such as all-party parliamentary groups;

11.12. provide appropriate financial support.

1 Assembly debate on 3 October 2007 (33rd Sitting) (see Doc. 11344, report of the Social, Health and Family Affairs Committee, rapporteur: Mr Flynn). Text adopted by the Assembly on 3 October 2007 (33rd Sitting).

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